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Home My WebLink AboutWake_Well Abandonment_20231122 (4) I • pMj,!, L ABANDONMENT RECORD For Internal Use ONLY: I• 1.Well Contractor Information: WELL ABANDONMENT DETAILS Austin Fowler 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only l GW-30 is needed. Indicate TOTAL NUMBER of 4366-A wells abandoned: i 4 NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.) I CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY: Company Name NA 7c.Type of disinfectant used: t 2.Well Construction Permit#: List all applicable well construction permits(i.e.VIC,County,State,Variance,etc.)iflutown NA 7d.Amount of disinfectant used: 3.Well use(check well use): i Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) 19Residential Water Supply(single) ❑ Sand Cement Grout I ❑ Dry Clay ❑htdustrial/Commereial ❑Residential Water Supply(shared) ❑ Concrete Grout I ❑ Drill Cuttings ❑Irrigation ❑ Specialty Grout ❑ Gravel Non-Water Supply Well: i ❑ Bentonite Slurry 9 Other(explain under 7g) ❑Monitoring ❑Recovery Injection Well: 7E For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation Soil 5 Cubic Yards ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑StormwaterDrainage Crushed Concrete I —600 Ibs t t1 ❑Experimental Technology []Subsidence Control ^� 21t23 7g.Provide a brief description of the abandonment procedure: ❑Geothennal(Closed Loop) ❑Tracer ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Crushed concrete, from well housing, and to fill well. Well was dry. Concrete used to fill to —2 a.Date well(s)abandoned: 10/31/2023 feet below land surface and topsoil used to bring to 5a.Well location: grade. Apex Humie Olive NA Facility/Owner Name Facility ID#(if applicable) 8.Certification: 2236 Old US 1 Highway, Apex, NC 27502 11/6/2023 Physical Address,City,and Zip Signature of Certified Well Contractor or;Well Owner Date Wake County 0720998487 , By signing this form, !hereby certify,,that the wells) was (were) abandoned in County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Constniction Standards and that a copy of this record has b en provided to the well owner. 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one lat/long is sufficient) 9.Site diagram or additional well details: 35.699014 N -78.899416 W You may use the back of this page to provide additional well site details or well abandonment details. You may also attach additional pages if necessary. CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS Atlaclr ivell cotsiruction record(s)ifavailable. For nmltiple injection or not-watersupply wells ONLY with the saute cotstrttction/abattdonntent,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well 6a.Well ID#: WSW-2 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 20 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 i lob. For Iniection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter: (in.) 36 above, also submit one copy of tli I is form within 30 days of completion of well abandonment to the following: ) 6d.Water level below ground surface: Dry (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 , 6e.Outer casing length(if known): NA (ft) 10c.For Water Suualy&Iniection Wells: In addition to sending the form to the address(es)above,also submit one;copy of this form within 30 days of completion of well abandonment to the county health department of the county where 6E Inner casing/tubing length(if known): NA (ft) abandoned. 6g.Screen length(if known): Unknown i Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resource) Revised 2-22-2016 ! { � * #� e' �.:�. lik WSW-1 ®. WSW-�2 ` ® MW-5 MW;2 VIA ® DW-1 _ ® MW-3R O „MW-3 ' • MW-6 ® MW-4R MW V51 MW-4 Ox-O k LEGEND Monitoring Well ® (Type II) S ® Destroyed Monitoring A Well (Type II) OMonitoring Well A (Type III) Abandoned Non-Potable ` ® Water Supply Well ® Abandoned Potable Water Supply Well Approximate Location of Former USTs Parcel Boundary Source. Esri. Maxar. Earthstar Ge",graphics, and the GIS Use •ommunity NOTE: Well and tank locations were obtained from previous reports prepared by other consultants and are approximate. 40 20 0 40 80 Feet PROJECT UNION 76 --LE FIGURE ATLIN GASOLINE STATION SITE MAP C2236 OLD US 1 HWY 1 Engineers and Scientists APEX, NC INCIDENT NO I JOB NO DATE SCALE DRAWN BY'CHECKED BY 26571 220217 NOV 2023 AS SHOWN KMC/SJO i WELL ABANDONMENT RECORD For Internal Use ONLY: � I 1.Well Contractor Information: WELL ABANDONMENT DETAILS i Austin Fowler 7a.For Geoprobe/DPT or Closed-,Loop Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of 4366-A wells abandoned: !' NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 81 (gal.) CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY: Company Name Chlorine Powder 7c.Type of disinfectant used: 2.Well Construction Permit#: List all applicable well construction permits(i.e.UIC,County,State, Variance,etc)ifknown 3 oZ 7d.Amount of disinfectant used: 3.Well use(check well use): Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) RResidential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) S Concrete Grout ❑Drill Cuttings ❑Irrigation ❑ Specialty Grout ❑Gravel Non-Water Supply Well: ❑_Bentonite Slurry ❑Other(explain under 7g) ❑Monitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation Concrete 630 Ibs ❑Aquifer Storage and Recovery []Salinity Barrier ❑Aquifer Test ❑Stormwater Drainage ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the,abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Pump and tubing removed from from well and well was then filled to —5 feet below land surface with grout. a.Date well(s)abandoned: 10/31/2023 Grout was introduced via pumping into the well. 5a.Well location: Miller Land Group LLC NA Facility/Owner Name Facility ID#(if applicable) 8.Certification: 2237 Old US 1 Highway, Apex, NC 27502 %� 9 Yt ex p � 11/13/2023 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Wake Count 0720999210 Y By signing this form, I hereby certify,that the wells) tvas (were) abando ed in k z County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0 100 or 2C.0200 Well Constr11JiffVt,2dq d 2n23 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has ben provided to the well owner. ull (if well field,one lat/long is sufficient) 9.Site diagram or additional well details: 35.699065 N -78.898932 W You may use the back of this page to provide additional well site del-diis orwe,11.i abandonment details. You may also attach additional pages if necessary. CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS Attach well consttztction records)ifavailable. Formttltiple ityectiott ornon-ivatersupply wells ONLY with the same consvruction:abandonntent,you can submit one form. IOa. For All Wells: Submit this form within 30 days of completion of well 6a.Well ID#: WSW-3 abandonment to the following: i Division of Water Resources,Information Processing Unit, 6b.Total well depth: 72.5 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Iniection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter: Unknown (in.) above, also submit one copy of this form within 30 days of completion of well ; abandonment to the following: i 6d.Water level below ground surface: 16.80 (ft) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if known): Unknown (ft.) 10c.For Water Supply&Iniecti Wells: In addition to sending the form to the address(es)above,also submit one copy of this form within 30 days of completion of well abandonment to the county health department of the county where 6f.Inner casing/tubing length(if known): Unknown (ft.) abandoned. I 6g.Screen length(if known): Unknown (ft.) Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources) Revised 2-22-2016 uS1N OLO +r- FORMER PUMP ISLAND WSW-3 - i i MW=1 \ -n o � \ \ 1 .f£r G � # N ` MW-3 LEGEND ® Monitoring Well (Type ll) ® Abandoned Non-Potable Water Supply Well • - MW-2 -- Excavation Limits (CNL) 1% Approximate Location of Former UST System Parcel Boundary Source Esri. ',_�ograph _a a J she e _Omm'unity NOTES: 1. Well and tank locations were obtained from previous reports 20 10 0 20 40 prepared by other consultants and are approximate. 2. CNL= Could Not Locate Feet PROJECT TITLE MCNEIL'S GROCERY FIGURE ATLIN 2237 OLD US 1 HIGHWAY SITE MAP CAPEX, NC 1 Engineers and Scientists NCIDENT N0. JOB N0. DATE SCALE DRAWN BV;CHECKED BY 6891 220216 NOV 2023 AS SHOWN I KMC/SJO